Self-Care to Prevent Birth-Related UI in Diverse Women

描述（由申请人提供）：尽管有令人信服的证据表明，骨盆底肌肉训练（PFMT）可将育龄妇女的尿失禁（UI）风险降低高达39- 59%1;2;3，但采用并维持这种做法的育龄妇女太少。最近的审查重申PFMT是妊娠/产后的推荐做法4，但只有20-52%的育龄妇女报告使用5;3;6。此外，几乎所有以前的自我护理试验，以防止UI已与白人妇女。我们对老年女性进行的随机对照试验（RCT）测试了PFMT和膀胱训练（BT）联合自我管理计划的UI预防效果，应用了班杜拉的自我效能理论7：干预措施在强化课程中教授，并证明了双重预防效果8。此外，对PFMT的依从性很高（指导后3个月为82%），并且持续（12个月为68%）9。这些结果鼓励我们扩展我们当前的研究（NIH R 01 NR 07618，PI C. Sampselle）与此竞争的延续。为了确保足够的种族/民族代表性，我们将使用服务于不同患者的社区网站对非裔美国人和西班牙裔妇女进行过度抽样。目的1将确定在非洲裔美国人、高加索人和西班牙裔育龄妇女的不同样本中，强化产前膀胱健康课程预防产后12个月UI的有效性。目的2将检查依从性的能力，以调解自我效能与UI发病率的关联。目标3将探讨3个种族/民族群体之间的态度和策略，促进或阻止遵守。目的4将探讨首次出生后3年时膀胱健康课程的有效性。为了实现目标1和4，我们将在考虑人种/种族的意向治疗假设后进行单盲RCT。为了实现目标2，我们将评估的作用，坚持自我效能和UI之间的关系的调解人。如果目标1的假设得到支持，一个密集的膀胱健康类可能成为护理产妇的标准。目标2和3的结果将提供见解：坚持的中介作用和自我管理的促进者/障碍。目标4的结果将产生急需的长期数据，这些UI预防性自我护理实践的潜在利益。最终，我们打算进行有效性RCT，这将由本文提出的研究结果提供信息。 骨盆底肌肉训练（凯格尔运动）减少尿失禁，强烈建议孕妇和产后妇女，但很少有人这样做。这项研究将测试一种自我护理的组合，其中包括在一个多元文化的妇女群体中进行骨盆底肌肉训练，这些妇女怀孕了第一个，第二个或第三个孩子。在早期的一项研究中，这种自我护理的结合在一年后将女性失禁的风险降低了一半。如果成功，一个重要的新方法，以防止尿失禁将提供产妇患者。

DESCRIPTION (provided by applicant): Despite compelling evidence that pelvic floor muscle training (PFMT) reduces childbearing women's risk of urinary incontinence (UI) by up to 39-59% 1;2;3, too few childbearing women adopt and sustain this practice. Recent review reaffirms PFMT as recommended practice during pregnancy/postpartum 4, but only 20-52% of childbearing women report its use 5;3;6. Moreover, virtually all previous trials of self-care to prevent UI have been with Caucasian women. Our RCT with older women testing the UI prevention efficacy of a combined PFMT and bladder training (BT) self-management program applied Bandura's 7 self-efficacy theory: the intervention was taught in an intensive class and demonstrated a two-fold preventive effect 8. Furthermore, adherence to PFMT was high (82% at 3 months post instruction) and sustained (68% at 12 months) 9. These results encourage us to extend our current study (NIH R01 NR07618, PI C. Sampselle) with this competing continuation. To assure adequate racial/ethnic representation, we will over sample African American and Hispanic women using community-based sites that serve diverse patients. Aim 1 will determine the efficacy of an intensive antenatal Bladder Health Class to prevent UI at 12 months postpartum in a diverse sample of African American, Caucasian, and Hispanic childbearing women. Aim 2 will examine the capacity of adherence to mediate the association of self-efficacy with UI incidence. Aim 3 will explore the attitudes and strategies among 3 racial/ethnic groups that facilitate or deter adherence. Aim 4 will explore the efficacy of the Bladder Health class at 3 years post index birth. To accomplish Aims 1 and 4, we will conduct a single-blind RCT following intention-to-treat assumptions taking race/ethnicity into account. To accomplish Aim 2, we will assess the role of adherence as a mediator of the relationship between self-efficacy and UI. If Aim 1 hypotheses are supported, an intensive Bladder Health Class could become the standard of care for maternity patients. Aim 2 & 3 results will provide insights re: the mediating role of adherence and about facilitators/barriers to self-management. Aim 4 results will yield much needed long term data regarding the potential benefit of these UI preventive self-care practices. Ultimately we intend to mount effectiveness RCT, which will be informed by the results of the study proposed here. Pelvic floor muscle training (Kegel Exercise) reduces urinary incontinence and is strongly recommended for pregnant and postpartum women, but very few do them. This study will test a combination of self-care that includes pelvic floor muscle training in a multicultural group of women who are pregnant with their first, second, or third child. In an earlier study this combination of self-care cut women's risk of incontinence in half one year later. If successful, an important new way to prevent urinary incontinence will be available for maternity patients.